Paul Kim

Background/Objectives: Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive intervention for overactive bladder (OAB) typically utilized in patients for whom behavioural and pharmacological therapies do not work. The aim of this study is to identify predictors of progression to alternate minimally invasive treatment options following PTNS in patients with OAB refractory to medical and behavioural therapy. In addition, the aim of this study is to determine predictors of maintenance therapy after completing PTNS induction. Methods: This study is a retrospective cohort analysis of patients that underwent PTNS between March 2018 and June 2023 for management of overactive bladder. The primary outcome of this study is progression to alternate minimally invasive treatment options following PTNS, such as sacral neuromodulation or intradetrusor onabotulinum toxin injections. The secondary outcome of this study is the continuation of maintenance therapy following the initial 12-week PTNS treatment course. Results: A total of 49 patients were included for analysis. Overall, 33% (16/49) of patients had further alternate minimally invasive treatment. Multivariate logistic regression analysis identified only age (odds ratio (OR) = 1.06; p = 0.05) as a significant predictor of progression to alternate minimally invasive OAB treatment following PTNS. Overall, 27 (55%) patients continued with ongoing monthly maintenance PTNS after completing initial weekly treatment for OAB. Multivariate logistic regression only identified sex as a predictor of ongoing maintenance PTNS (OR = 13.2; p = 0.017). Conclusions: The present study identifies younger age as a significant predictor of progression to further minimally invasive OAB treatments after PTNS. Furthermore, female sex was found to be a significant predictor of ongoing maintenance PTNS.

Post-operative ureteric stents are commonly utilised after endoscopic intervention for urolithiasis to maintain ureteric patency due to the risks of post-operative ureteric obstruction from stone fragments, oedema or trauma from instrumentation. Unintended premature dislodgement and need for cystoscopic removal pose significant clinical and economic burden to the health care system. Alternative stents such as magnetic stents and stents on extraction strings (SOES) aim to reduce the need for removal under cystoscopy. There is a paucity of data in comparing these alternative stents directly to help guide which stent is more suitable for usage in post-ureteroscopy patients with urolithiasis. MAG-EX is a prospective, multicentre, randomised clinical trial conducted in two tertiary centres in Sydney, Australia. A total of 276 participants (138 per group) will be enrolled to detect an 8% difference in complication rates with 80% power and a significance level of 0.05. Adult patients undergoing ureteroscopy for unilateral stone disease will be randomised to receive either SOES or magnetic stents. The primary outcome is the rate of premature stent removal or requirement for cystoscopic removal within one week. Secondary outcomes include patient-reported measures such as Ureteral Stent Symptom Questionnaire (USSQ), Visual Analogue Scale (VAS), and Patient Reported Outcome Measures (PROMs), as well as patient satisfaction and cost analysis. Follow-up will occur at stent removal and at 30 days post-insertion. Data will be collected using Research Electronic Data Capture (REDCap) and analysed in a blinded manner. This trial aims to determine if magnetic stents or SOES are more reliable in preventing premature stent removal and removal requiring cystoscopy. The MAG-EX trial will measure and compare the rates of premature ureteric stent removal and removal of ureteric stents under cystoscopy between stents on extraction string and magnetic stents. A comparison of costs and patient reported outcomes between the two types of stents will be used to inform clinicians, patients and health care providers. This will establish which alternative ureteric stent is more suitable for usage in post-ureteroscopy patients with urolithiasis. Australian New Zealand Clinical Trials Registry: ACTRN12624000215527.

Background/Objectives: Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially fatal immunological conditions that affect cutaneous and mucosal surfaces and have the potential to involve the genitourinary tract. While genital involvement is common, urological manifestations are under-recognised clinically and there is a paucity of clear, evidence-based management pathways specific to urological manifestations of SJS/TEN. To map the spectrum of urological manifestations of SJS/TEN, to describe the short- and long-term outcomes of these manifestations, and to synthesise management and prevention strategies to inform clinical practice. Methods: This was a scoping review conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guideline. Data sources: Medline and PubMed articles published in English with publication date up to December 2025. Study selection: Eligible studies included case reports, case series, observational studies, clinical guidelines, and review articles describing urological manifestations, outcomes, management, or prevention strategies for patients with SJS/TEN. Articles limited to renal or isolated gynaecological involvement were excluded. Data extraction and synthesis: Articles were screened independently by two reviewers using a pre-defined data extraction template covering four domains: urological manifestations, outcomes and sequelae, management strategies, and prevention strategies. This criterion was refined after a pilot of 20 studies. Discrepancies were resolved by consensus with a third reviewer. Formal risk-of-bias assessment was not performed, consistent with scoping review methodology. Results: One hundred and four studies published between 1987 and 2025 were included in this review. Selected articles included case reports (n = 63), retrospective cohort studies (n = 23), prospective studies (n = 2), guidelines (n = 5), and summary articles (n = 11). Reported urological involvement ranged from genital cutaneous and mucosal disease including erosions, adhesions, and balanitis to urethral manifestations such as urethritis, stenosis, and strictures, as well as scarce upper urinary tract involvement including ureteric stricture and ureteric mucosal sloughing. While some manifestations resolved with supportive care, others progressed to chronic sequelae including persistent urethral strictures, voiding dysfunction, sexual dysfunction, recurrent infection, and in rare cases, obstructive uropathy. A multidisciplinary approach was recommended for all patients with SJS/TEN. Urological management centred around early and repeated urogenital examination, manual lysis of adhesions, urinary catheterisation, and timely intervention for urethral or ureteric obstruction. Long-term urological follow-up of 12 months was recommended for patients with significant urogenital involvement. Conclusions: Urological manifestations of SJS/TEN are diverse, clinically significant, and frequently under-recognised. Early urological involvement, systematic genital and urinary tract assessment, and proactive preventative measures may reduce long-term morbidity. This review provides a comprehensive synthesis of knowledge and recommendations to support urologists’ role in multidisciplinary care of patients with this pathology. This review also highlights the need for prospective research to guide further evidence-based management of urological complications of SJS/TEN.

Background/Objectives: Ureteric stents are commonly used in urological procedures. However, they can cause pain; haematuria; voiding symptoms; or stent migration. When stent migration occurs, this can cause a significant impact on the patients’ therapeutic outcomes and may warrant a repeat procedure to retrieve or replace the ureteric stent. This study aims to assess if there are any patient; stent; or operative factors that may increase the risk of stent migration. Methods: This is a single-institute, retrospective cohort study that looked at patient; stent; and operative factors for 828 ureteroscopies and or laser lithotripsy for management of ureteric or intra-renal calculi over a 2-year period. The 828 procedures comprised 655 patients, as some patients had multiple procedures. Results: From the 828 cases, there was a 2.7% incidence of stent migration; all episodes of stent migration were distal migration. Stent migration was more likely among females (odds ratio (OR) = 3.0; 95% confidence interval (CI) [1.2; 7.1]) compared to males; older aged groups (over 65 years) (OR = 2.7; 95% CI [0.9; 7.8]) compared to the young aged group (16–44 years); and those who were obese (OR = 2.1; 95% CI [0.9; 5.0]), had musculocutaneous (MSK) conditions (OR = 2.7; 95% CI [0.9; 8.3]), neurological conditions (OR = 3.3; 95% CI [1.1; 10.0]), and stent dwelling time ≥ month (OR = 2.3; 95% CI [0.9; 6.0]) compared to <1 month. There was no observed association between stent and operative factors. Conclusions: Patient factors such as sex; age; comorbidities; and weight need to be considered by urologists in conjunction with modifiable stent factors to ensure that the decisions are made on an individual basis to try and reduce the risk of stent migration.

Objective: To identify the association between cardiopulmonary exercise testing (CPET) and outcomes of radical cystectomy (RC), as RC is historically associated with high rates of short‐ and long‐term morbidity and mortality. Methods: This quantitative systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. An electronic literature search was conducted to identify all relevant studies evaluating the relationship between CPET parameters and RC outcomes. The primary outcome was short‐term mortality. Secondary outcomes included hospital length of stay (LOS) and rate of serious adverse events as defined by the Clavien–Dindo classification. Results: The search identified six studies for inclusion. A total of 546 patients underwent CPET prior to RC. There were significantly more deaths following RC observed in patients with poorer cardiopulmonary function (risk ratio RR 5.80, 95% confidence interval 4.96–6.78). There was no significant association between CPET parameters and adverse events or hospital LOS. Conclusions: The present systematic review and meta‐analysis identified a greater risk of 90‐day mortality in patients with poorer cardiorespiratory function, as measured by CPET. However, there remains a paucity of robust clinical data and further high‐quality studies are required to verify these results.

Objectives: ChatGPT is a large language model that is able to generate human-like text. The aim of this study was to evaluate ChatGPT as a potential supplement to urological clinical practice by exploring its capacity, efficacy and accuracy when delivering information on frequently asked questions from patients with bladder cancer. Methods: We proposed 10 hypothetical questions to ChatGPT to simulate a doctor–patient consultation for patients recently diagnosed with bladder cancer. The responses were then assessed using two predefined scales of accuracy and completeness by Specialist Urologists. Results: ChatGPT provided coherent answers that were concise and easily comprehensible. Overall, mean accuracy scores for the 10 questions ranged from 3.7 to 6.0, with a median of 5.0. Mean completeness scores ranged from 1.3 to 2.3, with a median of 1.8. ChatGPT was also cognizant of its own limitations and recommended all patients should adhere closely to medical advice dispensed by their healthcare provider. Conclusions: This study provides further insight into the role of ChatGPT as an adjunct consultation tool for answering frequently asked questions from patients with bladder cancer diagnosis. Whilst it was able to provide information in a concise and coherent manner, there were concerns regarding the completeness of information conveyed. Further development and research into this rapidly evolving tool are required to ascertain the potential impacts of AI models such as ChatGPT in urology and the broader healthcare landscape.

Urinary tract infections (UTIs) are highly prevalent and have significant implications for patients. As internet-based health information becomes more relied upon, ChatGPT has emerged as a potential source of healthcare advice. In this study, ChatGPT-3.5 was subjected to 16 patient-like UTI queries, with its responses evaluated by a panel of urologists. ChatGPT can address general UTI questions and exhibits some reasoning capacity in specific contexts. Nevertheless, it lacks source verification, occasionally overlooks vital information, and struggles with contextual clinical advice. ChatGPT holds promise as a supplementary tool in the urologist’s toolkit, demanding further refinement and validation for optimal integration.